Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study

Brandão, Giovana Viotto Cagnon; Pereira, Elizandra Gomes; Haddad, Gabriela Roncada; Miot, Luciane Donida Bartoli; Marques, Silvio Alencar; Miot, Hélio Amante

doi:10.1016/j.abd.2023.01.001

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ORIGINAL ARTICLE • An. Bras. Dermatol. 99 (1) • Jan-Feb 2024 • https://doi.org/10.1016/j.abd.2023.01.001 copy

Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study^☆ ☆ Study conducted at the Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly.

Objectives:

To characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease.

Methods:

Cross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%.

Results:

In the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls.

KEYWORDS
Aged; Chronic disease; Immunosenescence; Metabolic syndrome; Psoriasis

Variables		EPso (n = 64)	APso (n = 64)	ESans (n = 64)	p-value
Age in years, mean (standard deviation)		65 (5)	42 (9)	67 (5)	-
Sex, n (%)	Female	34 (53%)	29 (45%)	34 (53%)	0.630
Sex, n (%)	Male	30 (47%)	35 (55%)	30 (47%)	0.630
Phototype, n (%)	I–II	5 (8%)	4 (6%)	17 (27%)	0.176
	III–IV	56 (88%)	57 (89%)	47 (73%)
	V–VI	3 (5%)	3 (5%)	- (-)
Level of schooling, n (%)	Elementary School	49 (77%)^a a p-value < 0.05 (post-hoc analysis).	27 (42%)	39 (67%)	0.001
	High School	6 (14%)	25 (39%)^a a p-value < 0.05 (post-hoc analysis).	11 (17%)
	Higher Education	6 (9%)	12 (19%)	14 (16%)
Family income, n (%)^b b R$ 1.00 = Us$ 0.19 (28/Nov/2022).	<R$ 1.000,00	9 (14%)	7 (11%)	3 (5%)	0.004
	1–3.000,00	42 (66%)	32 (50%)	37 (58%)
	3–5.000,00	13 (20%)	22 (34%)	15 (23%)
	>5.000,00	- (-)	3 (5%)	9 (14%)^a a p-value < 0.05 (post-hoc analysis).
Current smoking, n (%)		13 (20%)	11 (17%)	10 (16%)	0.840
Alcohol consumption, n (%)		10 (16%)	22 (34%)	15 (23%)	0.050

Variables		EPso (n = 64)	APso (n = 64)	p-value
Psoriasis onset (age)^a a Mean(standard deviation).		44 (13)	28 (11)	<0.001
Family history, n (%)		21 (33%)	26 (41%)	0.463
PASI^b b Median (P25–P75).		4 (2–9)	5 (2–11)	0.332
	PASI ≥10	13 (20%)	18 (28%)	0.410
BSA^b b Median (P25–P75).		6 (4–15)	9 (4–18)	0.402
	BSA ≥10	19 (30%)	26 (41%)	0.267
PGA body^b b Median (P25–P75).		2 (2–3)	3 (2–3)	0.734
PGA scalp^b b Median (P25–P75).		1 (0–2)	1 (0–2)	0.727
Skindex-16^b b Median (P25–P75).	Symptoms	17 (0–46)	25 (0–50)	0.429
	Emotional	23 (2–63)	27 (11–73)	0.219
	Functional	0 (0–35)	7 (0–40)	0.056
Palmoplantar, n (%)		16 (25%)	21 (33%)	0.436
Ungual, n (%)		46 (72%)	41 (64%)	0.449
	Onycholysis	36 (56%)	28 (44%)
	Pitting	17 (27%)	23 (36%)
	Trachyonychia	7 (11%)	3 (5%)
Arthritis, n (%)		14 (22%)	10 (16%)	0.498
	Hands/wrists	11 (17%)	7 (11%)
	Knees	4 (6%)	4 (6%)
Treatment, n (%)	Topical CTC	64 (100%)	55 (86%)	0.003
	Calcipotriol	16 (25%)	18 (28%)	0.842
	Methotrexate	30 (47%)	37 (58%)	0.288
	Acitretin	24 (34%)	34 (53%)	0.110
	Phototherapy	11 (17%)	8 (13%)	0.620
	Immunobiologicals	11 (17%)	12 (19%)	0.999
	Cyclosporine	1 (2%)	0% (-)	0.999

Variables		EPso (n = 64)	APso (n = 64)	ESans (n = 64)	PR1 (EPso × APso)	p-value¹ 1 Comparison between EPso and APso (gender-adjusted data).	PR2 (EPso × ESans)	p-value² 2 Comparison between EPso and ESans (data adjusted for sex and age).
BMI in kg/m², mean (SD)		28.3 (4.5)	28.5 (5.6)	28.5 (6.3)	-	0.394	-	0.136
BMI in kg/m², mean (SD)	BMI > 30	22 (34%)	26 (41%)	25 (39%)	0.9 (0.7–1.1)	0.393	1.0 (0.8–1.1)	0.548
Abdominal circumference in cm, mean (sd)		98,7 (14,4)	100.7 (11.9)	101.6 (14.2)	-	0.129		0.357
Diabetes mellitus, n (%)		19 (30%)	9 (14%)	14 (22%)	2.0 (1.0–4.0)	0.038	1.1 (0.8–2.6)	0.087
Hypertension, n (%)		38 (59%)	13 (20%)	30 (47%)	2.9 (1.7–5.0)	<0.001	1.3 (1.0–1.7)	0.039
Dyslipidemia, n (%)		33 (52%)	26 (41%)	25 (39%)	1.3 (0.9–1.8)	0.231	1.4 (1.1–2.1)	0.045
	LDL	22 (34%)	9 (14%)	14 (22%)	1.4 (1.1–1.9)	0.020	1.1 (1.0–1.3)	0.103
	Triglycerides	8 (13%)	7 (11%)	4 (5%)	1.1 (0.9–1.3)	0.564	1.2 (1.0–1.5)	0.107
	Both	3 (5%)	10 (16%)	6 (9%)	0.7 (0.5–0.9)	0.006	0.9 (0.7–1.2)	0.552
Cardiovascular event, n (%)		7 (11%)	4 (6%)	7 (11%)	1.0 (1.0–1.1)	0.313	1.0 (0.9–1.1)	0.733
Beck scale, median (p25–p75)		6.0(3.0–11.5)	6.5 (2.0–12.0)	5.0 (2.0–8.0)	-	0.779	-	<0.001
Beck scale, median (p25–p75)	Beck ≥10	22 (34%)	20 (31%)	13 (20%)	1.0 (0.6–1.7)	0.890	1.7 (0.9–3.1)	0.068
Physical frailty indexes in the elderly Handgrip in kg, median (p25–p75)		3.5 (0.0–10.0)	–	5.0 (0.0 –10.0)	-	-	-	0.094
Fatigue, n (%)^a a Fatigue: defined by those who answered negatively to the question “Do you feel full of energy”.		38 (59%)	-	23 (36%)	-	-	1.7 (1.2–2.4)	0.003
Sit-to-stand test, n (%)^b b Complete Sit-to-stand test: able to sit on and stand up from the chair five consecutive times.		60 (93%)	-	59 (92%)	-	-	1.0 (0.9–1.1)	0.895
Weight loss >5% (%)		17 (27%)	-	12 (19%)	-	-	1.5 (0.8–2.8)	0.239

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[1] ⁎ Corresponding author. E-mail: heliomiot@gmail.com (H.A. Miot).

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Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study☆ ☆ Study conducted at the Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.

Abstract

Background:

Objectives:

Methods:

Results:

Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study^☆ ☆ Study conducted at the Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.